Healthcare Provider Details

I. General information

NPI: 1629291257
Provider Name (Legal Business Name): QURRAT-UL-AIN NAWAB M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W TOWNLINE ST
CRESTON IA
50801-1054
US

IV. Provider business mailing address

1700 W TOWNLINE ST
CRESTON IA
50801-1054
US

V. Phone/Fax

Practice location:
  • Phone: 641-782-2131
  • Fax: 641-782-6425
Mailing address:
  • Phone: 641-782-7091
  • Fax: 641-782-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2008008630
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2008008630
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number41906
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number41906
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1629291257
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer
# 2
Identifier1629291257
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 3
Identifier200197550A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer
# 4
Identifier200557000B
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: